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PDE5 Inhibitor Pregnancy: Not applicable

Tadalafil (BPH)

Brand names: Cialis, Adcirca

Adult dose

Dose: 5 mg
Route: oral
Frequency: once daily
Max: 5 mg/day
Licensed for BPH and erectile dysfunction; avoid if eGFR <30 ml/min; absolute CI with nitrates

Paediatric dose

Route:
Not licensed in children for BPH

Dose adjustments

Renal

Avoid if eGFR <30 ml/min

Hepatic

Avoid in severe hepatic impairment (Child-Pugh C)

Clinical pearls

  • Only PDE5 inhibitor licensed once daily for BPH — also addresses coexistent erectile dysfunction
  • Nitrate interaction is absolute contraindication — potential fatal hypotension
  • MTOPS trial: combination therapy more effective than monotherapy for BPH progression

Contraindications

  • Nitrates (absolute — fatal hypotension)
  • eGFR <30 ml/min
  • Severe hepatic impairment
  • Recent stroke/MI (<90 days)
  • Hypotension (BP <90/50)

Side effects

  • Headache
  • Dyspepsia
  • Back pain
  • Myalgia
  • Flushing
  • Nasal congestion
  • Hypotension

Interactions

  • Nitrates (absolute contraindication)
  • Alpha-blockers (hypotension)
  • CYP3A4 inhibitors (ritonavir — max 10 mg/72h)

Monitoring

  • Blood pressure
  • Symptom scores (IPSS)

Reference: BNFc; BNF 86; NICE NG97; SPC tadalafil. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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